Basic Information
| Provider Information | |||||||||
| NPI: | 1487642849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESTER HOSE COMPANY INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 ROUTE 80 | ||||||||
| Address2: | |||||||||
| City: | KILLINGWORTH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064191400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606633634 | ||||||||
| FaxNumber: | 8606633795 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064121117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605260019 | ||||||||
| FaxNumber: | 8605266450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | CASTIEVETRO | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AGENT | ||||||||
| AuthorizedOfficialTelephone: | 8606633634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | C026B2 | CT | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | P00174598 | 01 | RAILROAD MEDICARE | OTHER | 004216546 | 05 | CT | MEDICAID |